Connecting Career and Mental Health Counseling ...

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Suggested APA style reference: Lenz, J. G., Peterson, G. W., Reardon, R. C., & Saunders, D. E. (2010). Connecting career and mental health counseling: Integrating theory and practice. Retrieved from

Article 1

Connecting Career and Mental Health Counseling: Integrating Theory and Practice

Paper based on a program presented at the 2009 National Career Development Association conference, July 2, 2009, St. Louis, MO.

Janet G. Lenz, Gary W. Peterson, Robert C. Reardon, and Denise E. Saunders

Lenz, Janet G., Assistant-In, Educational Psychology and Learning Systems Department; Program Director for Instruction, Research, & Evaluation, FSU Career Center, Florida State University. Dr. Lenz has 30+ years of experience in the career services field, is an NCDA Past-President and Fellow; she coordinates the FSU Master's/EdS. program in career counseling, and has research interests related to career interventions in higher education and the application of cognitive information processing in career services.

Peterson, Gary W., is Professor Emeritus and former Clinical Training Director and Program Coordinator for the academic program Psychological Services in Education, College of Education, Florida State University. He continues to serve as a volunteer Senior Research Associate in the Center for the Study of Technology in Counseling and Career Development. His research interests include career problem solving and decision-making, career assessment, test construction, and program evaluation in educational and human service settings.

Reardon, Robert C., Professor Emeritus, Educational Psychology & Learning Systems Department, Florida State University; Senior Research Associate, Center for the Study of Technology in Counseling & Career Development. His most recent co-authored books include Career Counseling and Services: A Cognitive Information Processing Approach (2004) and Career Development and Planning: A Comprehensive Approach (2009). He is the author of the computer-and Internet-based Interpretive and Professional Reports for the SelfDirected Search (self-directed-).

Saunders, Denise E., is a licensed psychologist in private practice in Chapel Hill, NC. She has over 17 years experience in the career development and counseling field providing mental health and career counseling and consultation to a diverse clientele. Dr. Saunders' interests in practice and research have focused on the connections between career and mental health counseling and understanding the complexities of the career decision-making process.

Ideas and Research You Can Use: VISTAS 2010

Introduction

In recent years, various authors and researchers have stressed the need for a more holistic approach to counseling that combines career and mental health issues (Blustein, 2006, 2008; Chopra, 2009; Krumboltz, 1993; Zunker, 2008). This paper focuses on strategies for combining career and mental health counseling assistance, and provides examples from a university-based career services setting and private practice. Prior to sharing the case examples, additional background information is provided on issues related to a service delivery approach that combines career and mental health assistance clients. The authors describe how using theory and selected assessments can enable career counselors to take a more holistic perspective when integrating career and mental health issues.

Organizational Considerations

For organizations considering combining career and mental health counseling, there are several strategic issues to consider. Career and mental health counseling services may share common ground in terms of philosophy, theory, and research, but the most difficult barriers to a holistic approach may occur with program implementation. This section describes some of the issues in combining these services and of making a combined service a reality in a postsecondary setting. Some of the issues raised may also apply to other organizational settings, e.g., hospitals, workforce centers, and community organizations.

Institutional Culture and Policies On many campuses, mental health counseling and career counseling services are

delivered by separate offices with unique histories and missions. These distinct histories may mitigate against a holistic service. Staff members who know the organizational history between counseling and career services may have strong opinions about this matter. Connecting mental health and career counseling within a particular setting, such as a career center, would likely require administrative approval at the highest levels of the organization.

Administrative Structure This structure and naming of an organization with seamless mental health and

career counseling has important implications for program marketing and public relations. If the name and identity of the unit is too "clinical," persons with career problems might be less likely to seek assistance. Conversely, if the image is too "vocational," it might reduce the credibility of the unit for those in psychological distress.

Space, Records, Tools, Resources In considering a combined office, one can imagine a single reception room that

would have individuals seeking help with choosing a major or finding a job in the same waiting area as those with mental health issues. There is also the matter of the kinds of records that would be needed to support a combined office, and where these records might be kept. Ethical practice for these types of counseling services requires attention to

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all of the typical forms used in a more "traditional" counseling setting (e.g., informed consent, intake forms, etc.). Finally, there are considerations related to resource allocation. What kinds of information materials (e.g., career books, self-help books on anxiety management and conflict resolution) would be needed in an agency providing both career and mental health counseling? Career and mental health services typically use a broad range of assessments of interests, personality, anxiety, mental functions, or stress. Would fees be charged for both career assessments and mental health assessments, or only for the former? These issues about space, materials, and resources get to the heart of organizational issues related to combining mental health and career services.

Professional Identities Mental health counselors typically have identities in psychology, mental health

counseling, professional counseling, or related fields, while career services staff often have identities in business or education. A question arises about the extent to which these identities are compatible or reconcilable? How will accrediting agencies view the staffing patterns and credentials in organizations that combine career and mental health counseling?

Supervision, Training, Liability Another issue in a combined service involves how professional development and

training are provided. How much emphasis should there be on cross-training? Moreover, do staff members need to have all of the credentials (e.g., licensure, certification) to supervise the full range of staff or is this constrained in some way? Finally, the matter of supervision and training is tied to professional liability of staff in terms of the laws affecting the provision of mental health and counseling services. Are career and mental health staff properly insured, credentialed, and prepared to provide services in both areas and where they overlap?

In the section that follows, some of the general issues discussed above are further elaborated by highlighting how services are provided in one university-based career services office.

Applying Theory in Career and Mental Health Counseling: A University-Based Example

This section describes how one university career center integrated career and mental health counseling using a theory that captures both aspects of a client's situation. It is important to note that this career services setting has long served as a training site for master's and doctoral level students in counseling and counseling psychology. The center views training career practitioners as part of its mission. In addition, a key factor in providing integrated counseling services is the center's partnership with faculty from the Psychological Services in Education program. They have office space in the center, provide training and supervision to counseling students, and conduct research in the center.

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A Theory Based Approach to Service Delivery Faculty involvement with the career center is closely tied to the development and

application of career theory in the center. The paper's authors have all contributed to the development of the cognitive information processing approach (CIP) to career problem solving and decision making (Peterson, Sampson, Reardon, & Lenz, 2006; Sampson, Peterson, Reardon, & Lenz, 2004), and the related instrument, the Career Thoughts Inventory (CTI; Sampson, Peterson, Lenz, Reardon, & Saunders, 1996). Using what is called a Pyramid of Information Processing, CIP theory captures traditional elements of career counseling, self-knowledge, options knowledge, and decision making, while also emphasizing the importance of meta-cognitive thinking in the career problem-solving process. CIP theory is concerned with clients learning how to solve career problems and make career decisions. In the service delivery process, clients collaborate with their career advisor in developing an Individual Learning Plan (ILP).

CIP theory also emphasizes how negative thinking can impede a person's ability to solve career problems and progress through the decision-making process, and uses a five-step problem-solving model called the CASVE cycle that includes Communication, Analysis, Synthesis, Valuing, and Execution. According to Sampson et al. (2004), negative thinking can impact all aspects of the pyramid and the CASVE cycle. Negative thinking is measured using the Career Thoughts Inventory (Sampson et al., 1996). In a later section, the authors discuss how CTI results can be applied in integrating career and mental health counseling. CTI research studies support the idea of a link between a person's ability to be an effective career decision maker and a wide variety of mental health issues, including depression, neuroticism, and anxiety. For additional examples of research related to CIP and the CTI, visit career.fsu.edu/techcenter.

Staff Training and Expertise

As noted earlier, one critical aspect in the integration of career and mental health counseling is staff training and expertise within the setting. The career center described in this article includes a number of staff with PhDs in counseling. The center also funds a faculty position that oversees instruction, research, and evaluation. The center's director, who is a licensed psychologist, has a courtesy appointment within the Educational Psychology and Learning Systems department. Further, two staff members who work in the center's advising and counseling unit have master's degrees in career counseling and are National Certified Counselors.

This staffing pattern matches well with the center's mission of providing counseling students training and supervision that includes attention to clients' mental health and career issues. For schools or other settings considering a service mission that includes addressing career and mental health concerns, it is important to insure that selected staff have the proper credentials to oversee those providing these services. Obviously, in settings where counselors-in-training are part of the direct services staff, this would be a mandatory part of supervision.

Another important consideration is onsite training for students and staff who are providing counseling services. Both the current and former supervisor of the center's direct services designed the in-house training program to include an emphasis on the theoretical basis for services, and to incorporate other basic counseling concepts (e.g., including screening for suicide, ability to refer to community-based services). In addition,

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the center has developed policies and procedures that accommodate an approach that blends mental health and career issues. This includes having the appropriate forms that reflect current ethical standards(e.g., client intake data, confidentiality, informed consent, and related documents). While these may seem obvious to any place that is focused on client counseling services, some career services centers may not view themselves as a site where these types of materials and policies are needed.

This university-based career services setting is able to effectively integrate career and mental health counseling by applying CIP theory and concepts from John Holland's RIASEC theory (Holland, 1997). The career advising and counseling services incorporate the notion of a clients' readiness for career services based on their capability and the complexity of their situation (Sampson, Peterson, Reardon, & Lenz, 2000). A clients' readiness for career problem solving and decision making determines whether they are assigned to self-help, brief-staff assisted, or individual counseling services (Sampson, 2008). Persons assigned to individual counseling have low readiness, along with low capability and a very complex situation that indicates that the client's concerns are likely impacted by both career and mental health issues. In the section below, we illustrate how assessments are used to gather data to inform a more integrated approach to service delivery in the context of a case study drawn from the career center's doctoral practicum.

Assessment Issues Integrating career and mental health counseling raises important considerations

regarding the use of assessments to diagnose mental health conditions, as these influence the career decision-making process. These considerations include:

(1) How are career assessments influenced by a client's mental health status? (2) What are examples of assessments that bridge career and mental health

domains? (3) How are these assessments used in developing and individualized learning plan

(ILP)?

Three assessments are presented that capture a range of mental health influences that potentially impact clients' career situations. The relationship of high to low scores is shown in parenthesis for each instrument below:

Career Thoughts Inventory (CTI; high career, low mental health) Decision Space Worksheet (DSW; medium career, medium mental health) Minnesota Multiphasic Personality Inventory (MMPI; low career, high mental

health).

A case study is presented to illustrate how these assessments can be used to integrate mental health considerations in the career counseling process.

The Career Thoughts Inventory (CTI) The CTI identifies dysfunctional thoughts that may impede the career problem-

solving and decision-making process. To assess specific client needs, the CTI includes three construct scales: Decision-Making Confusion (DMC); External Conflict (EC); and

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Commitment Anxiety (CA). The use of these constructs in career and mental health assessment is described below.

Decision-Making Confusion. The DMC scale taps into dysfunctional thoughts and emotions involved in formulating and evaluating appropriate career alternatives (Sampson et al., 1996). Items in this scale indicate feelings of depression and anxiety, or confusing thoughts that interfere with the acquisition of self knowledge and occupational knowledge and in identifying and considering plausible career options (Saunders, Peterson, Sampson, & Reardon, 2000). High DMC scores suggest the presence of disabling emotions and the possible need for additional mental health assessments that determine the intensity and chronicity of these emotions, especially in the case of depression.

External Conflict. The EC scale assesses the extent to which individuals can balance the views of significant others with their own values in the career decisionmaking process. High scores on this scale may indicate the presence of locus of control issues as clients prioritize viable career options and arrive at a first choice for a course of action (Saunders et al., 2000). EC items may highlight clients' needs for addressing relationship issues, especially with regard to how they may impact career decision making, as part of the counseling process.

Commitment Anxiety (CA). The CA scale measures the extent to which individuals experience fear and trepidation in implementing a first choice of a course of action (Sampson et al., 1996). The anxieties associated with committing to a career option may be specifically related to the career choice in the present (i.e., state anxiety), or they could be exacerbated by more fundamental personality proclivity (i.e., trait anxiety; Saunders et al., 2000). High CA scale scores could indicate the need for further assessments to determine the respective contribution of state and trait anxieties.

The CTI is a useful tool to help clients and practitioners screen for readiness to engage in the career counseling process and aid in identifying potential areas that can keep clients stuck in the process. Examination of the CTI total score and scale scores (DCM, CA, and EC) can assist counselors in recognizing areas to explore further with clients. Issues of self-doubt, tension surrounding uncertainties about the future and choices, and influences of family, culture, and societal norms can all be revealed when CTI results are explored with clients. Working closely with clients to review and discuss the CTI scores and related items, often raises client awareness of underlying personal and mental health issues.

The Decision Space Worksheet (DSW) The DSW is a cognitive mapping task that enables clients to reveal thoughts,

feelings, persons, and circumstances associated with a career decision. The DSW also helps clients prioritize the importance of contextual influences on their career decision. First, clients record, in their own words, the career decision they wish to make. Second, they list all elements on a lined sheet that impact the decision. Third, on a second page, clients are instructed to draw circles within a given large circle in proportion to the relative importance of each element listed on the first page as it bears on the career decision. Typical issues revealed in the DSW activity include financial, family, education, interests, self-doubt, anxieties, employment prospects, and quality of life

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(Peterson & Leasure, 2004). This technique enables both the client and counselor to understand the social and emotional context out of which the career problem arises.

Once the list and the map are completed, a counselor helps the client explore the complexity (Sampson et al., 2000) of the career problem by asking how the map represents the client's perceptions of the career decision space. Clients are prompted to share how they felt about the task itself, and secondly, to talk about how the list and the map relate to the presenting career decision. In this way, counselors gain a perspective from the client's point of view, and avoid the possibility of projecting their own perspective on the map. The counselor next asks the client more detailed questions related to how each element influences or bears directly or indirectly on the career decision at hand. As the client draws connections between each element and the career decision, the counselor may ask about relationships between and among elements and how they interact with each other. Often, related elements form inter-related clusters of elements that comprise a theme. Finally, the amount of open or unused space may also be subject to interpretation. Unused space may represent unarticulated sources of anxiety and tension in an individual's life, or it could represent the proportion of non-career and related concerns in a client's life. Since the mapping task is also a projective assessment, the allusion to mental health and personal adjustment factors in the list and the circles, such as family and relationship issues, financial concerns, as well as personality and emotional elements, is quite common. If any mental health issue is seen as constraining the identification of career options or causing the inappropriate elimination of options, addressing these issues can be included in the ILP.

The Minnesota Multiphasic Personality Inventory (MMPI-2) One of the unique aspects of service delivery in the authors' setting is the use of

the MMPI-2 (Hathaway & McKinley, 1942) as part of the assessment process for selected counseling clients seen in the context of an advanced doctoral practicum. The MMPI-2 is used judiciously following the indication of mental health issues related to a client's CTI results and DSW. The MMPI-2 can provide important information regarding how mental health issues might impact clients who present for career counseling. In addition, certain MMPI-2 scale scores have implications for client career decision making, and for the career counselor's choice of interventions (Peterson & Githens, 1990). Some of these scales are described below.

The Correction (K) scale is considered a measure of ego strength and measures the extent to which individuals possess the cognitive resources to manage stress. Scores in the 50 ? 60 range are most adaptive. Low scores may indicate vulnerability to stress whereas high scores suggest rigidity. Individuals with moderate K elevations may adapt well to jobs with above average stress; they tend to be well organized, efficient, and steady employees. In career counseling, they tend to task oriented and problem focused.

The Depression (D) scale is a mood scale that measures the clinical syndrome of depression. Individuals earning high scores may be slow in movement and thought and they may experience suicidal thoughts. Low scores typically indicate cheerfulness and optimism. In career counseling, individuals earning elevated scores may not fully engage the career problem-solving process and may reject plausible or appropriate career options without full consideration.

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